Since March is Endometriosis Awareness Month, I’m excited that Dr. Tosin Odunsi-Akanji (Instagram: @lifebytosin), one of my fave physicians to follow on social media, took time out of her busy schedule to write a post to increase awareness of how the diagnosis can impact not only physical health, but also mental health.
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Imagine dreading a specific time of the month every month for 14 years. Imagine feeling like you’re being stabbed by hundreds of knives. That was me every time my time of the month paid me a visit. If I was able to, I would spend the first couple days in bed armed with ibuprofen and a heating pad. After a gastrointestinal workup in college came back normal, I figured the pain was normal and must be the cramps women complained about.
Eventually, I said something to my gynecologist and was placed on birth control pills without an interrogation of the pain. This helped bring the intensity of my chronic pain down from an 8/10 to a 4/10. I was more than okay with that. Fast forward to my third year of medical school when I was studying for my USMLE Step 2 Board Exam. One of the practice questions asked for a complication of endometriosis. The answer was ‘infertility.’ I immediately started crying because by this time I suspected this was what I had and I thought I would end up infertile. Soon after that, I was awakened from sleep with severe abdominal pain. I ended up having surgery and finally received a diagnosis of endometriosis.
What is endometriosis? It is a chronic disorder in which the tissue that forms the lining of the uterus (the endometrium) is found outside the uterus where it does not belong. These implants respond to changes in estrogen and may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen which can cause severe pain throughout the month. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.
The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP), painful periods, painful intercourse, and infertility. Symptoms of endometriosis often affect psychological and social functioning of patients. For this reason, endometriosis can be considered as a disabling condition that may significantly interfere with social relationships, sexuality, and mental health. If this is the case, then an important area to consider is the impact of anxiety and depression on the management of women with endometriosis.
Several studies have been conducted to showcase the influence of CPP on psychological well-being and quality of life of women with endometriosis. Women with endometriosis have a higher risk of developing anxiety, depression, and other psychological symptoms, according to a review study published in the International Journal of Women’s Health. Data suggests that the experience of pelvic pain may significantly affect emotive functioning of affected women. Furthermore, high levels of anxiety and depression can amplify the severity of pain. Additional studies are needed to better understand the relationship between psychological factors and perception of pain.
Treatment of endometriosis may be hormonal or surgical. Surgery is the primary treatment for severe forms of endometriosis. There is not much data in the literature about the influence of psychological factors and psychiatric co-morbidities on the effectiveness of treatments. It is important to evaluate the presence of previous psychiatric diseases in order to select the most appropriate treatment for these patients.
Endometriosis affects roughly 10% of women of reproductive age. On average, endometriosis can take six to ten years to diagnose and three out of five women with endometriosis were told by at least one doctor that nothing was wrong. In my own experience with endometriosis, I did not have an answer for what was causing my pain for 14 years. It is not surprising that part of my life revolved around my menstrual cycle. March is Endometriosis Awareness Month. Perhaps more attention can be paid to women who have psychiatric complaints in addition to CPP in order to better tailor treatment.
For more on Dr. Tosin Odunsi-Akanji, MD, MPH, you can find her on YouTube and Instagram.
References:
The American College of Obstetricians and Gynecologists. Frequently Asked Questions.
https://www.acog.org/-/media/
Anxiety and Depression in Patients with Endometriosis: Impact and Management Challenges
SpeakEndo
